CCS Organizational Application Form

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Congress of California Seniors

Please print a copy and complete the following member/affiliation application form:


Organization Application

Yes, our organization wants to be a member / affiliate of CCS. We would like to join in the following category.

1 to 50 Members ---------------- $30
51 to 100 Members ------------- $75
101 to 250 Members ---------- $100
251 to 500 Members ---------- $125
501 to 1,000 Members -------- $150
1001 or more Members ------- $300
Contributing Membership -- $1,000
Sustaining Membership ----- $2,500

Enclosed is our check in the amount of: __________

Name of Organization _________________________________

Your Name _________________________________________

Your Position________________________________________

Address ____________________________________________

City _____________________ State _____ Zip + 4 _________________+ _ _ _ _

Phone ________________ E-mail: ________________________

Referred By __________________________________________

Please make checks payable to CCS

Mail to: Congress of California Seniors
1230 N Street, #201
Sacramento, CA 95814

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Congress of California Seniors
1230 N Street, #201
Sacramento, CA 95814
(800) 543-3352
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